Journal of Orthopaedic Surgery and Research 2013, 8:9
doi:10.1186/1749-799X-8-9

Published: 26 April 2013

Abstract

Background

In the literature, little is known about the level and pattern of rugby injuries.
Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65%
of all match injuries affected the shoulder.

Objective

The study aims to describe a sport-specific unique intra-articular shoulder pathology
of professional rugby players, who presented with persistent pain and dysfunction
despite physiotherapeutic treatment and rest.

Method

This study is a retrospective analysis set at a university sports medicine clinic.
Eighty-seven professional rugby players, referred by their professional medical team
since they could no longer play, underwent shoulder arthroscopy between June 2001
and October 2007 due to persistent shoulder pain and dysfunction. All were full-time
professional male rugby union and rugby league players. They all had failed conservative
treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings
were used as a measure of main outcome.

Results

The primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main
operative finding was that most patients exhibited multiple shoulder pathologies,
with 75% of cases presenting with two or more pathologies. A superior labrum anterior
to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%),
while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears,
excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort.

Conclusions

Repeated tackling, which is clearly rugby specific, is most likely to be responsible
for most of these shoulder injuries, which upon arthroscopic examination, showed signs
of mixed pathology. We suggest that an early arthroscopic investigation is valuable
in this population in order to confirm treatable diagnosis on the painful shoulder
and expedite a safe return to play.